跨越人体中线的肩胛皮瓣微血管构筑研究

目的：观察跨越人体中线的肩胛皮瓣内的微血管情况。方法：采用乳胶混合液对一侧的旋肩胛动脉皮支进行灌注后，将皮瓣取下制成透明标本，分区观察微血管构筑。结果：乳胶混合液的灌注范围都可跨越人体中线区。皮瓣各层中血管均有动脉弓、交通支、动脉网3种吻合形式。各层之间相互连接，相互吻合。结论：以一侧的旋肩胛动脉皮支为蒂，血流可跨越人体中线而达到对侧的肩胛区。跨中线肩胛皮瓣内的血管由深到浅，从一侧至另一侧相互沟通、交错，构成了一个三维立体网状环形通路。中线区域的血管吻合形式多样且范围较广。皮瓣远端血管吻合部位主要集中在对侧肩胛冈上区，整个皮瓣血管网有向远端肩峰侧倾斜的趋势。提示在临床应用过程中，术前设计形成跨中线皮瓣时，皮瓣远端最好在对侧肩胛下角以上，向对侧的肩峰区偏斜。

Microvascular structure of the transmidline scapular flap

Objective To investigate the microvascular structure of the transmidline scapular flap pedicled with the unilateral circumflex scapular artery. Methods Latex and ink mixture was injected into the unilateral circumflex scapular artery of 6 fresh cadavers. The transmidline scapular flap was dissected and the pellucid specimen was made. The artery perforators were traced to their underlying parent vessels that accompanied the segmental arteries. A series of cross-sectional studies were undertaken in one subject to illustrate the course of the perforators in the tissues of different depth. Results In deep and superficial fascia, the subdermal and dermis layer, rich microvascular connection was found which showed in three patterns: the vascular arch, communicating branches, and the arterial rete. They interrelated to form a three-dimensional framework. The vascular tree not only passed the midline but also reached the contralateral acromion. The densest vessels were exhibited at the injection side of the back. In the midline area the vessels were in less density and at the contralateral side, the vessels mainly concentrated in the upper part of the back. Conclusion The result evidenced the vascular pattern and the applicable safety of the transmidline scapular flap. In elevating a transmidline scapular flap, the distal part should mainly locate at the upper part of the back.